PGY-4 Entry Programs

Program Highlights

The University of Toronto, Division of Cardiology, is an internationally renowned institution for clinical care, research, and education of physicians at all levels of training. As well, it is an integral component of cardiology training for general internal medicine trainees at the University of Toronto. The division also provides training to postgraduate trainees in research and subspecialties in cardiology from all over the world. The division offers a training program in cardiology, which is accredited by the Royal College of Physician and Surgeons of Canada, and allows trainees who successfully complete the program to sit for the specialty examination in adult cardiology.

The University of Toronto Postgraduate Internal Medicine Residency Training Program in Cardiology is three years in duration, with further fellowship training available in subspecialties as required or desired. Upon completion of the program, trainees will have a high degree of skill and knowledge in all aspects of clinical cardiology, and a demonstrated ability to act as consultants to other physicians. As the division’s expertise is spread over three physical sites; St. Michael’s Hospital, Sunnybrook Health Sciences Centre, and The University Health Network – Mount Sinai Hospital, trainees within the cardiology training program will rotate across all sites, which allows them exposure to cardiology staff at all three sites. Trainees will be exposed to state-of-the art non-invasive cardiac diagnostics including echocardiography, stress testing and nuclear imaging. Invasive laboratories providing facilities for cardiac catheterization, and percutaneous intervention provide support to modern day CCUs at all sites. Specialized electrophysiology laboratories provide experience in EP studies, catheter ablation and device management. The division’s large critical mass (~90 GFT cardiologists) and referral population provide trainees with a unique training environment and exposure to clinical patients and problems that may not be readily available elsewhere.

There are exceptional educational opportunities for the cardiology trainees, including local bedside and professorial rounds, local teaching rounds in the CCU, Echo-Doppler, nuclear, advanced cardiac imaging, electrophysiology and cardiac catheterization and hemodynamic laboratories. Trainees are expected to participate in Cardiology Grand Rounds, Research Rounds and at city-wide University Rounds. In addition, there are monthly cardiology core teaching rounds that are held on Tuesday afternoons. Trainees are expected to partake in research projects and are afforded the opportunity to present their projects to peers, the division, and at national and international cardiology meetings. In order to ensure that educational objectives are being achieved, the Postgraduate Training Committee, consisting of the training program director, local hospital training co-ordinators, and resident representatives from each year of training meet on a regular basis. The program is extremely receptive to trainee feedback on educational experiences.

Program Highlights

Clinical Immunology and Allergy is a subspecialty concerned with the investigation, diagnosis and management of medical conditions involving the immune system with an emphasis on allergic, autoimmune and immunodeficiency diseases.

The Adult Clinical Immunology and Allergy Residency Training Program is a two-year subspecialty program, which candidates complete following core internal medicine training. Our program draws from the strengths unique to University of Toronto’s Faculty of Medicine, with a distinguished history of innovation and internationally renowned research, clinical training and educational excellence.

Trainees will be provided with a rich, supervised clinical experience in both adult and paediatric clinical immunology and allergy. While based at St. Michael’s Hospital, residents have the opportunity to work in several teaching hospitals and community clinics. Due to the wide-ranging expertise of our faculty, diverse patient population and strong interdisciplinary collaborations, trainees will become competent in diagnosing and managing both rare and common immunologic and allergic conditions.

Residents will work with renowned content experts in adult immunology and allergy, as well as paediatrics, otolaryngology, rheumatology, occupational medicine, respirology and dermatology. With a close link to SickKids hospital and the Department of Paediatrics, learning activities include a robust academic half-day and teaching rounds. The program aims to tailor training to meet each resident’s career goals, providing opportunities for research, medical education and teaching, or increased experiences in community practice.

• PGY4 & PGY5 Curriculum
• PGY4 & PGY5 Training Electives

Program Highlights

The University of Toronto Clinical Pharmacology and Toxicology training program is one of only three such programs in the country. Applications are accepted from trainees in internal medicine, emergency medicine, psychiatry, pediatrics, anesthesia and, most recently, public health and preventive medicine. The residency program is very flexible and can be tailored to a primary specialty. In some instances, trainees are able to pursue dual training in another subspecialty program (for example, critical care, geriatrics, etc.) concomitantly.

The training program follows the Royal College of Physicians and Surgeons of Canada objectives of training, which are updated regularly. Each resident is expected to do a six month block of his or her primary specialty along with two three-month blocks of two other specialties. A full year of elective experiences constitutes the second year of training. A mandatory lecture series and examination are expected to be completed within the two years. Trainees are expected to participate in research, and a variety of options are available to this end.

Opportunities for trainees are numerous, with many partners across the University, in industry, and in regulatory medicine. These include epidemiologic research in drug safety, occupational and environmental exposures, quality and safety, therapeutics, addiction medicine, administration, critical care, public health, emergency medicine, geriatrics, drug development, laboratory toxicology and pharmacogenetics.

Program Highlights

The mandate of the University of Toronto, Critical Care Medicine Residency Training Program, is to develop leaders in critical care and foster the development of competent, caring and resourceful intensivists. There are a large number of opportunities for research and development in the areas of basic science, physiology, clinical trials, clinical epidemiology, ethics, and education. The success of our program lays in the diversity of our faculty and breadth of the educational opportunities provided by the various academic and community ICUs.

The rapidly expanding body of knowledge regarding the treatment of the critically ill, the continuing introduction of new technology for life support, and more complex societal issues (legal, moral, ethical) have created a need for specialists trained in the recognition and management of this patient subset. To develop such specialists, our residency program focuses on the knowledge, skills, and attitudes pertinent to the expected roles and competencies of the adult critical care medicine specialist. Residents training within the unique interactive environment in which the critically ill are managed learn to respect the rights of the patient and family and acknowledge the importance of age, gender, culture, and ethnicity.

Program Highlights

The goals of the program are to develop future leaders in endocrinology, including researchers, educators and community endocrinologists. The program provides a very strong clinical base in first year, then allows for a highly individualized second year curriculum, designed to offer trainees the best training for their desired future endocrinology career. Our program emphasizes the development of both exemplary clinical skills as well as the scholarly skills required for our trainees to succeed in both academic and community settings.

Mainstream Program (Two Years)

Our program is committed to training gastroenterologists with a strong interest in scholarly pursuits. At least 21 months of the two year training program is designated to clinical rotations that are comprised of in-patient and consultative gastroenterology/hepatology service, in addition to a multi-site ambulatory clinic rotation, a concurrent six-month longitudinal outpatient clinic, a community block, a combined nutrition-motility rotation, two months of elective blocks and adequate endoscopy experience.  During the PGY-5 year, trainees have a three-month research block to explore an in depth research project. At the University of Toronto, the training program provides breadth and depth of learning, with the opportunity for exposure to the multiple facets of gastroenterology and hepatology via:

• basic and specialized training in luminal gastroenterology at all sites
• advanced training in hepatology, transplantation and exposure to a strong autoimmune and viral hepatitis ambulatory program based at Toronto Western Hospital (TWH)
• acquisition of diagnostic and therapeutic procedural skills: endoscopy, liver biopsy, paracentesis (all sites) and exposure to advanced therapeutics St. Michael's Hospital (SMH)
• acquisition of research (clinical, epidemiologic, translational or basic) skills during a protected three-month protected research block during the PGY-5 year
• To encourage the pursuit of scholarly work, we have established an annual Hepatology Research Day and a University of Toronto, Division of Gastroenterology & Hepatology Research Day, where gastroenterology residents, clinical and research fellows, and general internal medicine trainees may showcase their research
• Exposure to a comprehensive core curriculum (academic half-day) teaching program, which includes clinical, physiology, pathology and radiology teaching, in addition to specific CanMEDS objectives (ethics, quality assurance etc.) The CAG Basic Science (Nation-wide Videoconference) Rounds are integrated into the academic half-day.

Resident Research Track

We are pleased to introduce the gastroenterology resident research track within the current Gastroenterology & Hepatology Residency Training Program, offering a research focused program with a third year. 

Applicants are required and interested trainees should submit a short research proposal, in conjunction with a University of Toronto research supervisor. The trainee should contact Dr. Jill Tinmouth for a list of potential research supervisors. Dr. Tinmouth will also facilitate the application process for this track.

Applicants accepted via the CaRMS adult gastroenterology subspecialty match process will receive funding for the initial two years via the Ministry of Health. For trainees in the research track, the third year of funding will be contingent on procurement of funds either by the trainee, or with assistance from the supervisor or the division. Each trainee will work with his/her research supervisor to identify research grant funds, research training fellowships or other sources of funding for their third year. In addition, within the PGY-4 year, each trainee in the research track will be required to submit an application to the clinician-scientist program at the University of Toronto, and concurrently the Clinical Investigator Program, Ministry of Health and Longterm Care.

If the research track position does not fill, the position will be allocated to the mainstream program.

Goals:  
1. To identify and recruit applicants who are more likely to pursue a research career in gastroenterology;
2. To provide a research environment conducive to the mentoring and development of future, basic clinical or translational clinician-scientists in gastroenterology.

Description of Program:

Three years (two years of Gastroenterology & Hepatology residency training as per the standards (goals and objectives) of the Royal College of Physicians and Surgeons of Canada, plus a third research year) for a total of 18 months of research.

Six month research block (either in two three-month blocks  or one six-month consecutive block) within the first two years of training, third  year dedicated entirely to research).

Detailed application guidelines are provided on the CaRMS website.

Goals and Objectives

Program Curriculum

The training program is distributed across multiple teaching sites, providing exposure to various faculty members and mentors. There are education site-based directors and representatives from research, hepatology, endoscopy and in-training evaluation on the education committee.

There are regularly scheduled teaching/academic rounds at each hospital. In addition, there are monthly City-Wide Gastroenterology & Hepatology Rounds, Hepatobiliary Rounds, quarterly divisional Quality Improvement Rounds, weekly Inflammatory Bowel Disease Rounds (MSH) and interval scheduled Inflammatory Bowel Disease Research Rounds, attended by faculty (local, national and international), trainees and community collegues. 

The trainees also rotate through rotations at partially affiliated health care institutions:in the community:

• North York General Hospital
• St. Joseph’s Health Science Centre
• Credit Valley Hospital       

At the University of Toronto, there is representation of the diverse aspects of clinical gastroenterology by internationally recognized programs, including gastrointestinal oncology, inflammatory bowel disease, genetics, hepatology, therapeutic endoscopy, nutrition, liver transplantation. Research within the division includes basic science and translational research, epidemiology, clinical trials, clinical outcomes and health informatics.

PGY-4 – PGY-5:

• 10 months core luminal rotations
• Four months core hepatology rotations (two months in-patient, two months predominantly ambulatory)

PGY-5 year: 

Three months research (for mainstream program vs. six months for research track), two months ambulatory block, one month community block, one month combined nutrition – motility, one month liver transplantation, two elective months,  six-month longitudinal ambulatory clinic. There will be a slight modification of the research track to accommodate six months of research.

Program Highlights

The aim of the University of Toronto, General Internal Medicine (GIM) Residency Training Program is to train leaders in GIM. Our program offers support for trainees to tailor the curriculum to their individual career needs. Learning activities include faculty designed and lead academic half-days, simulation-based sessions, a longitudinal consultation-focused ambulatory clinic, GIM Journal Club, international electives, and opportunities to participate in educational and research activities. Available scholarly streams include: obstetrical medicine, clinical epidemiology, quality and patient safety, technology for patient care, and innovations in medical education.

Program Highlights

Our mission statement: We will provide the best educational experience possible, that meets and exceeds the Royal College of Physicians and Surgeons of Canada requirements and is tailored to the individualized goals of our trainees.

To that end, we pride ourselves on the commitment to offering a flexible program of the highest calibre. Our program is designed to allow the resident to meet his or her learning needs and to prepare them for practice in geriatric medicine in a variety of settings. A large and diverse faculty at multiple sites allow for an excellent experience in many different models of geriatric care provision. Excellent research opportunities are available within the program.

Program Highlights

The Adult Hematology Residency Training Program is a two-year program in hematology with additional optional year devoted to clinical or laboratory research. The program is organized into an 18-month core program and six-month of electives. International electives are also offered. Longitudinal ambulatory care is offered to trainees from the beginning of their first year. Trainees will experience a benign longitudinal clinic during their first year and a malignant longitudinal clinic during their second year of training. Residents also participate in weekly academic half days throughout the two years of training on key topics in hematology as well as workshops exploring non-medical expert CANMEDS roles. Protected times away for these teachings is mandatory.

Program Highlights

Infectious Diseases training in Toronto will provide the trainee with the largest and most diverse clinical experience in the country. Because of the large and diverse population in Toronto, the depth and breadth of clinical material is exceptional. This includes a large HIV patient population, the largest transplant centre in the country and unique and varied clinical and basic research opportunities. The program has a large and experienced faculty that provides exceptional clinical supervision, teaching and mentorship. A unique feature of the training program is the tropical medicine clinic, which provides an excellent opportunity for trainees to see and manage patients with a wide variety of acute and chronic tropical infectious diseases. Longitudinal ambulatory experience in infectious diseases, including a group practice in the second year of training, is a key component of the educational experience.

Program Highlights

The University of Toronto, Medical Oncology Residency Training Program, trains residents in the clinical and scientific aspects of the diagnosis and comprehensive management of patients with neoplastic diseases. The primary purpose of the program is to produce well-trained medical oncologists who are knowledgeable in all aspects of cancer care, but with specific skills in the use of systemic therapies for treating patients with cancer. Ultimately, the goal of the program is to ensure that all trainees achieve the specific objectives set out in the Royal College of Physicians and Surgeons of Canada's specialty committee's 'Objectives of Training in Medical Oncology.'

The guiding philosophy of the University of Toronto, Division of Medical Oncology Residency Training Program, is to recruit the best possible candidates and train them to be the future leaders in oncology in Canada and the world.

Program Highlights

The Division of Nephrology at the University of Toronto is an exciting division with world-class scientists, clinicians, and teachers working together to steadily improve patient care and deliver consistently outstanding education. The division offers training in all renal replacement therapy modalities, including home and in-centre hemodialysis, peritoneal dialysis, and transplantation, as well as consultative and follow-up care for patients with all types of kidney disease. In addition, our faculty participates in a full range of academic activities including basic science, translational and clinical research, and teaching. Our division is considered to be one of the leading institutions for training nephrologists for both academic careers and clinical practice in North America. A two-year residency in nephrology is available for physicians who have completed a residency in internal medicine.

Upon completion of training, a resident is expected to be a competent specialist capable of assuming a consultant's role in nephrology. The resident must acquire a working knowledge of the theoretical basis of the specialty, including its foundations in the basic medical sciences and research.

Only candidates certificated by the Royal College of Physicians and Surgeons of Canada in internal medicine may be eligible for the Certificate of Special Competence in Nephrology.

On completion of the program, the resident who is competent in nephrology will be able to demonstrate the knowledge, attitudes and skills needed to independently care for patients with kidney disease (including the management of chronic kidney disease, dialysis and renal transplantation) and with disturbances of acid-base, fluid and electrolyte metabolism; and also glomerular, genetic, hypertensive, and diabetic kidney diseases.

The resident will have a working knowledge of the basic sciences (physiology, pathophysiology and immunology) and applied sciences pharmacology, pathology) as they apply to renal disease and their treatments. The resident who is competent in nephrology will be able to conduct himself/herself as an attending physician and a consultant, work effectively in a variety of healthcare settings (acute and chronic care hospitals, dialysis units (hemodialysis and peritoneal dialysis), ambulatory care clinics (general nephrology, pre-dialysis, renal transplantation) and function as a member of a multi-disciplinary team effectively collaborating with other health professionals. S/he will demonstrate an awareness of the need for ongoing personal education and will be able to access and critically appraise required literature. S/he will be punctual, dependable and conscientious in the care of patients and will exhibit appropriate personal and interprofessional behaviours. The resident will incorporate gender, cultural and ethnic perspectives in the practice of nephrology as a clinician and/or researcher (methodology, data presentation and analysis}.

Program Highlights

Occupational Medicine is a branch of medicine that emphasizes prevention, and deals clinically and administratively with the health needs of both individuals and groups with respect to their working environments and includes the recognition, evaluation, control, management and rehabilitation of occupationally related diseases and injuries, and other conditions affecting ability to work.

Occupational Medicine aims to:

• Promote and maintain the highest degree of physical, mental and social well being of workers in all occupations;
• Prevent health problems caused by working conditions;
• Place and maintain workers in occupational environments compatible with their physical and psychological capabilities.

Upon completion of training, a resident is expected to be a competent subspecialist in occupational medicine capable of assuming a consultant's role in the subspecialty. The resident must acquire a working knowledge of the theoretical basis of the subspecialty, including its foundations in the basic medical sciences and research.

Only candidates certified by the Royal College of Physicians and Surgeons of Canada in internal medicine or public health and preventive medicine may be eligible for certification in occupational medicine.

Residents must demonstrate the requisite knowledge, skills, and attitudes for effective patient-centred care and service to a diverse population. In all aspects of specialist practice, the graduate must be able to address issues of gender, sexual orientation, age, culture, ethnicity and ethics in a professional manner.

Program Highlights

The mission of the Palliative Medicine Subspecialty Residency Program at the University of Toronto is to train outstanding palliative care subspecialists who will use clinical, academic and scholarly skills throughout their future careers to improve the quality of death and dying for patients and family members.

The program meets the specific training requirements set out by the Royal College. In the first year, trainees will acquire core palliative care knowledge and skills by rotating through palliative care services in a variety of inpatient, outpatient and community settings. In the second year, trainees will learn about the management of end-stage non-cancer illness through a series of focused off-service rotations. At the end of the second year, the trainee will complete another four blocks of core palliative care rotations during which the trainee will function as a “junior attending” in preparation for their transition to practice. Trainees will have 2 blocks of research and 2 selectives during their 2-years of training.

Trainees will be required to complete a scholarly or academic project during the course of their training. This project will be conceived, designed, conducted, analyzed and hopefully published by the trainee, under the supervision of a faculty mentor, on a topic of interest and relevance to the trainee. Elements of the academic half-day are devoted towards concept and design, and helping trainees get their projects going. Projects will be reviewed and evaluated in a peer-review format at the conclusion of the training program, and presented at the national meeting of the Canadian Society of Palliative Care Physicians at the end of the second year.

Program Highlights

The Adult Respirology Program at the University of Toronto is a two-year residency program accredited by the Royal College of Physicians and Surgeons of Canada. We provide comprehensive clinical training in Respirology, and the opportunity to foster an academic career with mentorship from world-class faculty. In our program, residents will find tremendous breadth and depth of clinical experiences, enthusiastic and approachable teachers, a well-developed formal curriculum, and exposure to cutting-edge respiratory research. Our goal is to develop exemplary clinicians and leaders in research and education.

A third year of training is optional and is not funded by the Ministry of Health. The third year of training is an opportunity to obtain additional experience in a specialized area of Respirology, and is often coupled with academic training.

Unique aspects of our program include:

Specialized Experiences

Our residency program offers unique exposure to specialty areas in Respirology:

• Lung Transplant
• Cystic Fibrosis and Bronchiectasis
• Sleep Medicine
• Pulmonary Hypertension
• Interstitial Lung Diseases
• Airways Diseases
• Pulmonary Rehabilitation
• Occupational Lung Diseases
• Lung Infections including Mycobacterial Diseases
• Rare Lung Diseases including Hereditary Hemorrhagic Telangiectasia, Hepato-Pulmonary Syndrome
• Interventional Pulmonary Medicine

Research

We have 2 blocks of dedicated time for Research, with the option of additional elective time. This can be clinical, basic science, quality improvement, or educational research.  The resident research experience is supported by a Research Advisory Committee, whose mandate is to connect residents with prospective supervisors and vet projects for feasibility and appropriateness.

Academic Half Day Curriculum

We have a robust formal curriculum covering all of the major topic areas in Respirology, including a radiology curriculum and a procedural skills curriculum with 5 simulation sessions per year.

Monthly Journal Club

Supervised by an associate editor at CMAJ, the journal club experience provides in-depth teaching in research methodology and critical appraisal. Our journal club engages an international audience (often including the authors of the paper) on Twitter.

Physiology and Pulmonary Function Testing Rotations

This comprises 2 blocks in the program. The first block occurs at the start of the residency program. Residents spend time getting hands-on teaching in the pulmonary function laboratory and learn interpretation strategies, complemented by weekly seminars in respiratory physiology. The second block occurs mid-way through Year 2. This block focuses more on advanced physiological studies including Stage 1 exercise testing, inhalation challenges, shunt studies, and sleep studies. Quality assurance and managerial aspects of the pulmonary function laboratory are also taught.

Quality Improvement Curriculum

Our Year 2 residents receive practical instruction in a longitudinal Quality Improvement curriculum, which includes participation in a quality improvement project.

Program Highlights

The objective of this program is to produce rheumatologists of clinical and academic excellence who become leaders in their chosen field.

On completion of the PGY-4 year, the trainee will be able to function as a consultant rheumatologist with supervision. This requires the trainee to be effective in the assessment, investigation, management, and rehabilitation of patients with acute and chronic common forms of arthritis, soft tissue rheumatologic disorders, collagen-vascular diseases and vasculitides, spinal and regional pain problems and the musculoskeletal manifestations of systemic disease.

On completion of this educational program (PGY-5 year), the graduate physician will be competent to function as a consultant rheumatologist independently. Through subspecialty clinics and focused experience, the graduate is expected to have a detailed knowledge of rheumatic diseases, pathogenesis and measures of disease impact, appropriate therapeutics and methodology for literature appraisal.